Laserfiche WebLink
Waste Tire SAey & Inspection Report Inspection Report Number <br />CalRecycle Staeo <br />t f Callycle 181 (Rev. 10/10) — <br />Dept. of Resources Recycling and Recovery (CalRecycle) <br />Survey Form Page 1 I1 1242085 <br />Dir+ e - cimro., RL11F OR BLACK INK PEN <br />Business Profile <br />V <br />Inspection Details <br />HAULING AND MANIFEST REQUIREMENTS <br />TPID -` <br />Site Suffix: 6 8 <br />Inspection Type (Fill one) <br />PRC § 42951 - Waste Tire Hauler Registration and Transport of Tires <br />Q <br />{ <br />19 Routine Q Re -inspection Q Referral Q Observation <br />If Referral, choose referral type (Fill one) <br />Visit Q Other <br />Local <br />Identifier:„ <br />Joaq,v�Y1 '`�719r�'/ <br />PRC § 42956 - Registration/Decal in Vehicle <br />Q CHP Q CalRecycle Q Complaint <br />Q Educational <br />Business or Facility Name <br />Q <br />Inspected By Inspector <br />14 CCR § 18459.1 - Tire Program ID Number from CalRecycle <br />f i'etti. 1 rick oa\&- <br />Q <br />14 CCR § 18459.2.1 - Submittal of Comprehensive Trip Logs within 90 days <br />Q <br />Physical Address <br />14 CCR § 18459.3 - Retention of Comprehensive Trip Logs for 3 years <br />Q <br />Q <br />1 <br />Q <br />Q <br />14 CCR § 18461 - Manifest System Requirements for Waste Tire End -Use Facilities <br />Q <br />Q <br />S c�c �oh CA <br />GS�s <br />Inspection Date o Q <br />o <br />Other: § <br />Time In <br />Time Out <br />Business Rep Title <br />O AM <br />, Z O0 <br />% O AM <br />`� 4& PM <br />i� <br />M �� �� <br />PM <br />Operational Status <br />Tire Type <br />Business Role <br />Storage Type <br />Tire Count (Whole/PTE)(Fill <br />3 <br />one only) <br />(Fill all that apply) <br />(Fill all that apply) <br />(Fill all that apply) <br />1* Active <br />Q Closed <br />Q Passenger <br />Q Altered <br />0 Generator <br />Q Hauler <br />10 Outdoor Z <br />Indoor 31 <br />O <br />GPS Latitude <br />Q Inactive <br />40 Truck <br />Longitude - <br />O <br />Q Planned <br />40 OTR <br />Q End -Use <br />Q Container <br />Business Type (Fill all that apply) <br />Q New Tire Dealer * Auto Repair Q Trucking Fleet <br />Q Government Q Retreader Q Dismantler Q Tire Derived Fuel <br />Q Used Tire Dealer Q Auto Body Q Car Dealer <br />Q Collection Q Crumb Rubber <br />Q Service Station Q Hauler Q Agriculture <br />Q Shredder Q Other <br />Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End -Use Facility <br />V <br />A <br />HAULING AND MANIFEST REQUIREMENTS <br />Q <br />Q <br />PRC § 42951 - Waste Tire Hauler Registration and Transport of Tires <br />Q <br />Q <br />PRC § 42953 - Contracts with Registered Waste Tire Haulers. <br />Q <br />Q <br />PRC § 42956 - Registration/Decal in Vehicle <br />Q <br />Q <br />14 CCR § 18459 - Responsible Entities Complying with Manifesting Requirements <br />Q <br />Q <br />14 CCR § 18459.1 - Tire Program ID Number from CalRecycle <br />Q <br />Q <br />14 CCR § 18459.2.1 - Submittal of Comprehensive Trip Logs within 90 days <br />Q <br />Q <br />14 CCR § 18459.3 - Retention of Comprehensive Trip Logs for 3 years <br />Q <br />Q <br />14 CCR § 18460.2 - Manifest System Requirements for Registered Waste Tire Haulers <br />Q <br />Q <br />14 CCR § 18461 - Manifest System Requirements for Waste Tire End -Use Facilities <br />Q <br />Q <br />14 CCR § 18462 - Manifest System Requirements for Tire Dealers or Waste Tire Generators <br />Q <br />Q <br />Other: § <br />ENFORCEMENT STATUS <br />Q Notice Of Violation Q Extension <br />Compliance Deadline <br />Datem/ M / m <br />(Required for NOV or EX7) <br />Q Referred / CalRecycle Enforcement <br />18 In Compliance - No Violations <br />Comments c_ �. -wa C� GYIo e <br />Inspection Form Included: U-�' `���� k.?5,6 20q^y�32ay <br />Comments Included: �— V <br />Business Rep's Signature Phone Number Inspector's Signature Phone Number <br />__]jj�jjjjjINSTRUCTIONS ON BACK Correct: Incorrect: X* NJ E X A M P L E 1 2 3 62081 <br />White Copy: CalRecycle Yellow Copy: Operator Pink Copy: LEA <br />